State concerned about mental health agency

New London - The commissioner of the state Department of Mental Health and Addiction Services is scheduled to meet today with top officials at Sound Community Services about its operations, including letters sent in October and November to more than 400 clients advising them to go elsewhere for their mental health medication prescriptions.

Those slated to attend the meeting with Commissioner Patricia Rehmer include Gail Lawson, the chief executive officer of Sound Community Services, and K. Michael Talbot of Groton, the chairman of its Board of Directors, according to James Siemianowski, spokesman for DMHAS.

One of the main issues on the agenda will be the serious shortage of staff licensed to prescribe medications that prompted the letters to the approximately 400 clients, who represent more than half of Sound Community Services' entire client roster. The clients were told in the letters to go to primary care doctors or hospital emergency rooms for medication refill prescriptions.

SCS has been under scrutiny by the state since August, after 21 former employees raised concerns in a letter about leadership and high staff turnover issues that they said are eroding patient care. The state has also been auditing the agency.

"The commissioner is meeting to discuss various issues and concerns," Siemianowski said. "We had been looking into the situation with prescribers, and it had seemed they were making progress, but some information we've received more recently indicates the progress has been undone, and it needs to be investigated."

No other outpatient mental health agency in the state has a similarly severe shortage of prescribers, he said.

"I'm not aware of any other providers that are currently having this problem to this degree," he said. "This is somewhat atypical."

Lawson did not respond to email and voice mail messages left Thursday and Friday requesting comment. Talbot, the board chairman, declined to discuss the purpose of the meeting with Rehmer.

"I've been invited to a meeting," he said.

Asked about the prescriber shortage and the letters to the 400 clients, Talbot said those kinds of issues are outside the board's purview.

"We're not involved in operations," Talbot said. "I'm not supposed to know those kinds of things."

The meeting today follows a visit Friday by a team from the Southeastern Mental Health Authority, a division of the state agency, to review records of the clients who received the letters and ensure that anyone with immediate needs will be receiving care, said Cheryl Jacques, chief executive officer of the Norwich-based SMHA. A private nonprofit agency, Sound Community Services is the region's largest provider of outpatient mental health services and receives the majority of its $10 million annual budget from state and federal funds.

"We're very, very concerned," Jacques said Thursday, explaining the reason for the visit Friday. "I need to know these people are stable and don't need to be seen immediately."

The letters, she said, left many of the clients "feeling that they were being left with no services." Sound Community Services, she said, should have informed SMHA before sending the letters. If it had done so, SMHA may have been able to send one of its prescribers to help out temporarily.

"I did not have any information prior to the letters going out," she said.

The prescriber shortage is primarily affecting the New London offices of Sound Community Services, which normally has two full-time staff who can prescribe medications. The Norwich office, Jacques said, appears to be fully staffed with one full-time prescriber. The situation came to her attention, she said, after several clients who received the letters began coming to SMHA's mobile outreach outpatient clinic for care.

SCS clients who received the letters have also been going to the Emergency Department at Lawrence & Memorial Hospital in New London seeking to refill prescriptions for their mental health medications, spokesman Mike O'Farrell said.

"We've definitely noticed an increase," he said. "Some of them have primary care physicians and some don't."

The hospital, he said, had no communication from SCS about the situation. If it had, the emergency department would have been better prepared, he said. The Emergency Department, he added, is not the ideal setting for this kind of care.

"They need to see someone who knows the patient well and what the treatment's been in the past," he said. "Our team is still trying to learn more."

After the SMHA team concluded its visit to Sound Community Services Friday, Jacques said she was pleased to learn that SCS staff had contacted or met with about 150 of those who received the letters about their prescriptions. Jacques said she is now expecting daily updates from SCS.

"This is a shared responsibility, and our priority needs to be on these individuals," she said. "This still needs some work, but I am feeling better about this immediate group of people. We also came up with a plan for them about how to move forward."

She said SCS appears to be close to hiring one or more new prescribers.

Siemianowski added that other health care agencies in the region that may be encountering SCS clients will be informed of the situation.

But nothing the SMHA staff learned in Friday's visit changed Commissioner Rehmer's mind about the need for the meeting today, Siemianowski said. Robert Davidson, executive director of the Eastern Regional Mental Health Board, said both the commissioner's meeting today and the visit from SMHA are highly unusual. The board is a Norwich-based nonprofit agency that evaluates mental health programs for the state in a 39-town region.

"For Patricia Rehmer to come down here on Monday in the middle of a (state) budget crisis with a very short timeline shows the importance she attaches to this," Davidson said.

The situation, he said, recalls the kinds of issues raised by the letter this summer from the 21 former employees.

"That things have gotten to this degree of seriousness and the way the agency handled it gives credence to the idea that management policies are behind it," he said. "At the very least, Sound did not make adequate provisions for continuity of care, so the client is not left with nothing."

In periodic meetings between representatives of mental health agencies from the region, he said, SCS staff could have informed their counterparts about the situation ahead of time, so they could better prepare and perhaps help the agency. Asked if he thought the situation could have been avoided, he replied, "absolutely."

To Jean Miner of Lyme, the former SCS clinician who wrote the July letter signed by her and 20 other former staff, the current situation provides further evidence of the problems at the agency that she said have been ignored for too long. Her letter was the second time in two years that employees went to the board with complaints about Lawson.

On Aug. 3, the board agreed to hire a consultant to investigate the issues raised in the letter. Talbot, the board chairman, said last week that the investigation is closed, but did not elaborate about whether the conclusion resulted in any board action.

"We were satisfied with the outcome," he said. "We did address the situation to the board's satisfaction."

Miner said neither she nor any other signers of the letter were contacted by the investigator.

"It's absolutely outrageous," she said. "None of the signers have heard from anyone, and there are a good 15 employees who also left since then who did not sign the letter that they could have talked to. Who are they talking to - each other in a room?"